Provider Demographics
NPI:1003036658
Name:CAMPBELL, INGRID SHARON (L-CSW)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:SHARON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:L-CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SEAVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-9797
Mailing Address - Country:US
Mailing Address - Phone:631-423-2817
Mailing Address - Fax:631-423-2817
Practice Address - Street 1:101 SEAVIEW TER
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2932
Practice Address - Country:US
Practice Address - Phone:631-423-2817
Practice Address - Fax:631-423-2817
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO42678-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical